Northeastern Society of Plastic Surgeons

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Modified Frozen Section Mohs (MFSM): A Novel Technique and One Plastic Surgeon's Experience with 1714 Consecutive Skin Cancer Removals
Michael L. Chang*3, Steven L. Chang3, Matthew Delancy1, Fady Gerges2, Lawrence Chang3
1Plastic Surgery, Cooper University Health, Camden, NJ; 2Green Clinics Laboratory, Dover, DE; 3ChristianaCare, Newark, DE

While U.S. non-melanoma skin cancer (NMSC) mortality has decreased in the past decade, its incidence is rising. Traditional surgical treatments are intraoperative frozen section analysis (IFSA) and Mohs Micrographic Surgery (MMS). Both techniques provide intraoperative analysis allowing the surgeon to confirm margins clear of malignancy and minimize tissue damage, especially in cosmetically sensitive subunits. MMS, with cure rates up to 99-100%, is considered the gold standard but is limited geographically and financially due to specialized training.

We developed a novel surgical technique that effectively excises cutaneous malignancy but can be utilized by plastic surgeons. This novel technique is called Modified Frozen Section Mohs (MFSM) which combines both techniques utilized in IFSA and MMS. MFSM is similar to IFSA in that the middle breadloaf visualizes the central deep margin, but is similar to MMS in that the entire periphery is also analyzed (Figure 1).

This is a retrospective review of all patients undergoing the MFSM procedure by one plastic surgeon from September 15th 2017 to June 15th, 2023. The primary outcomes were 1) recurrence, determined by excision of skin cancer demonstrated to be arising from post-excision scar tissue and 2) concordance between intraoperative and final pathology.

There were 1714 MFSM procedures performed with a cohort averaging 73.8 years old and 43% female. Zero recurrences were identified (100% cure rate). Two cases (0.11%) were false negatives and the patients returned for re-excision. About 48.2% of cases were BCC, 40.7% were SCC, and 7.5% of cases were melanoma. The average number of stages per MFSM procedure was 1.168 (Table 1). The mean defect size was 1.83 cm2. Complication rate was 2.28% (39/1714), mostly commonly by bleeding requiring suturing or cautery. Our proposed MFSM technique's results demonstrate effective carcinoma removal like that of MMS. Plastic surgeons may therefore utilize this technique to meet the growing burden of skin cancers in the U.S with equally effective outcomes.
Excision Rates and Stages for 1714 lesions
Number of excisions for clear margins 
11473 (85.94%)
2199 (11.61%)
336 (2.10%)
46 (0.35%)
Mean Number of Stages1.168
False Negative Rate2 (0.11%)
Number of Recurrences to Date0
Cure Rate100%



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